In this episode, CSI Specialty Group President and CEO Suzette DiMascio, CHE, CMCE, CPC, joins Intalere Senior Director, Corporate Communications, Evan Danis on the Illuminated Path podcast, to discuss her strategic insight on specialty pharmacy marketplace trends – specifically, what’s driving the explosive growth of specialty pharmacy.
Suzette also passionately speaks about her unwavering commitment to helping every healthcare provider, regardless of size, understand specialty pharmacy and the financial ROI it can provide to organizations.
Tune in to Discover:
- The factors behind the explosive growth of specialty pharmacy over the last few years
- Why health systems are on a mission to integrate specialty pharmacy into their outpatient offerings
- The current challenges faced by specialty providers to gain access to patients
- Why specialty drugs will continue to dominate the drug pipeline in the next 10-15 years
- How CSI Specialty Group can help organizations make their specialty pharmacy offerings the best they can be
About Evan Danis
Evan Danis is an innovative marketing and advertising professional with more than 20 years experience including marketing, general public relations, event planning, media and community relations and sales. MBA with a concentration in Management and Marketing.
His specialties include: media sales, government relations, comprehensive writing. public speaking and presentation, marketing, advertising, media buying, marketing collateral development, branding and brand management, lead generation.
About CSI Specialty Group
CSI Specialty Group is a globally recognized leadership, strategy and talent consulting firm dedicated to helping clients drive sustainable, accelerated growth while continually elevating the specialty pharmacy industry. By providing inventive specialty pharmacy consulting, workforce planning and talent acquisition solutions, CSI uniquely tailors its service offerings to help clients drive sustainable, accelerated growth. As the provider of the industry’s first, dedicated podcast for specialty pharmacy, CSI is at the forefront of pioneering innovative concepts to meet the changing needs of specialty pharmacy, home infusion, mail order/PBM, health systems and pharma/biotech clients across the USA and throughout Europe.
Speaker 1:0:05 You are listening to illuminated path, shining a light on health care’s best operational practices brought to you by [inaudible]. I’m your host everydayness, senior director of corporate communications at insular. Joining us in the studio today is Suzette Damasio, president and CEO of Intel air partners. CSI Specialty Group recognized internationally as a thought leader, industry expert, frequent media contributor, sought after speaker and educator of all things related to specialty pharmacy and the rare and orphan disease arena shows that strategic insight on marketplace trends help align and enlightened this continually pivoting industry understands that leadership, CSI specialty group has become the industry’s preeminent leadership consulting firm, offering strategic solutions to all healthcare market channels across the spectrum. Recent honors include being named one of consulting magazine’s fastest growing firms, Goldman Sachs, top growing businesses, and top 50 women owned businesses by Commonwealth Institute. Suzette. Welcome and thanks for joining us today. I’m hoping today we can educate our listeners on specialty pharmacy, some specifically what it entails, maybe break down what’s driving the explosive growth of this industry and why every healthcare provider, regardless of size, needs to understand it and explore how they might be able to leverage specialty pharmacy to reach corporate goals and make a real impact on organizational Roi.
Speaker 1:1:29 So with that, let’s get started. A couple of questions for you to start briefly defined for us what specialty pharmacy entails for our listeners from your perspective. Thanks for having me on the show. Evan. A specialty pharmacy is a growing part of a solution to take care of very chronically ill patients. It’s estimated by 20, 20 that over 50 percent of the outpatient drugs spend in general will be on specialty molecules. And if you think a specialty pharmacy, think of a patient that is suffering from a chronic illness, uh, whether it be hepatitis multiple sclerosis, Crohn’s disease, or potentially something very rare in the sense of Duchenne’s muscular dystrophy, our hereditary angio edema. So it’s a very chronically ill patient that needs a life sustaining medication, uh, in order to have any quality of life. Uh, oncology products also fall into this category as well, and they’re usually very high touch, a need, a lot of integration with the caregiver as well as a high cost as we all know. So based on that, I think you’ve, you’ve kind of explained specifically what’s driving its growth it seems like. But tell me a little bit more about that and why it’s grown so exponentially over the last several years. Well, in my opinion, it’s very simple. Once we broke the genetic code, uh, scientists were able to come up with different molecules to address a lot of genetic disorders that they never were able to. You take to Shane’s dystrophy
Speaker 2:3:00 for many years traditionally strikes a twin boys, uh, doesn’t strike women as much. The genome doesn’t hold a in the female cycle per se. I’m not a geneticist, but I play one on TV. Uh, and subsequently since they were able to find the marker for this catastrophic illness, they are now able to treat a, these kids. And in the studies that when one twin could take the drug and one twin couldn’t, uh, they were able actually to uh, slow down the progression of what typically is a death sentence. So it’s, it’s really revolutionary now with high technology and high r and D to develop these drugs comes a high cost and um, that’s kind of where I’m specialty has really become the forefront of consideration for employers, insurance companies to take a look at how do we mitigate the risk of taking care of these chronically ill patients when these drugs are so expensive.
Speaker 1:4:00 That’s a little bit about, you know, again, how important has become. So tell me a little bit then about how it’s important to integrated care of the patient. I think what you explained really tells a little bit about that, a little bit more about how it’s so important to integrated care. And there’s a specific example that we’ve talked about before that I’d love you to share with our audience as well.
Speaker 2:4:21 In the past five to six years, health systems have been on a mission to look at ways that they can integrate specialty pharmacy into their outpatient offering, uh, as we all know that outpatient pharmacy traditionally has looked at, been looked upon as a cost center, but now there’s an opportunity for them to really take a look at the triple aim and have a three 60 view of that patient. And that’s by offering specialty pharmacy services. And what we like to say in our firm is that not everybody needs to be a specialty pharmacy, but they need to have a specialty pharmacy strategy. And I’ll give you a case in point. Um, it’s a very poignant story. Uh, I was at a conference and a health system pharmacy director came to me and asked me if I could talk to them about what steps do they need to take to open a specialty pharmacy.
Speaker 2:5:13 And of course, I asked some typical questions and then my main question was, what made you look at this now? And she shared a story with me about a little girl that had had a liver transplant. And, uh, as you can imagine as a parent, uh, I have a son and I know you have children as well, uh, when you get the diagnosis that your child needs, a liver transplant just changes your life, your life stops right at that moment. And so this health system was able to take this, this 14 year old child from the brink of death to a successful transplant to discharge and at the time of discharge, as you can imagine, there’s a Marriott of drugs that she needs to take because they didn’t have a specialty pharmacy. Uh, they were locked out of the and they weren’t able to dispense the drugs that this child needed to sustain her life for the rest of her life.
Speaker 2:6:04 She’s on all these medicines. There were a certain amount of meds that they could and they, they left with those drugs. And then the rest of the drugs were called in by their pharmacists to another pharmacy that was going to dispense it. Drugs never got there. And she went into liver rejection. She entered the hospital, uh, and within a short period of time they lost her. And first of all, as a parent, every time I tell the story, I get a chill because a mother lost her child, you know, and being a mom, there’s no greater fear than something happening to your child. And it didn’t need to happen. It didn’t need to happen because if the health system was allowed to dispense that drug and take complete care of that patient at that moment, she wouldn’t have passed away, but they weren’t allowed that privilege because of our crazy systems and PBM lockouts. And that could be a subject for a whole nother podcast. But the bottom line is health systems now not only want to have a specialty pharmacy strategy, in many cases, they want to have a specialty pharmacy as well so that they can have a three 60 view of that patient and stop situations like this from happening.
Speaker 1:7:20 It’s a very powerful and poignant story and it really speaks to the importance of integrated care and where specialty works into that. So thank you very much for sharing that. It really, really brings it home. Um, and we talked a little bit when you started talking about that we talked a little bit about how we say not every system or every facility needs a specialty pharmacy, but they do need some sort of specialty pharmacy strategy and I think a lot of facilities, a lot of organizations are deciding where do we go, how do we start, what are some of the things to consider maybe when they’re trying to formulate that, that strategy of whether they want to install a specialty pharmacy partner by build how they want to do that. That’s a great. You actually almost answered it for me. My builder partner is always the first discussion. What we’re finding now is that most health systems will want to take a look at what that Roi means to them. Uh, for example, at 3:40 bed facility that’s got 300 more beds, it might financially make sense for them to do a specialty pharmacy, but for a rural
Speaker 2:8:23 clinic, um, that maybe has 10 specialty pharmacy patients a month, it doesn’t make financial sense for them at that point. So they’d look to partner. I know that until years coming up with some great solutions to help the plight of the rural health system as well as individuals that want to just expand their realm and specialty and we’re honored to be a partner in that.
Speaker 1:8:44 We talked a little bit to set off the top about your passion for Specialty Pharmacy and, and your, your company’s overall success. So tell me a little bit about how you see yourself in the marketplace, why you’re so passionate. Obviously, what heard a story that tells us why you’re so passionate about specialty pharmacy, but tell us a little bit about that in terms of building your business and, and, and how you’ve been able to help some systems large and small, um, figure out their way around the specialty pharmacy business.
Speaker 2:9:15 Well, I guess for me it’s, it’s been something since a child that I’ve always loved health care and you know, I figured at one point in my life I wanted to be a doctor and find a cure for cancer. So I like to think that maybe I, I’m not able to find a cure myself, but our, our, our clients and our partners are. And an example of that would be, um, the work that we did with Johns Hopkins, so they actually were really early adopters, especially pharmacy, and they came to us to help build out their solution and we basically did everything from designing the site, bringing in an architect, doing job aids, helping them with a call center, a all the way to getting them ready for accreditation. So as a complete build out, now that the market’s evolved a little bit, we’ll get called in for different things.
Speaker 2:10:01 But the reason that I think we’re able to be so successful is my team is passionate and they have an exceptional pedigree. I’ll put my team up against anybody in the marketplace. Um, they come from the industry. So they’ve come from those early innovators like accredo and curascript and at no specialty. And I think a lot of times what we tell them our clients to do is I’m not as important as we tell them not to do because my team’s been through the pitfalls, they’ve seen what’s worked and what’s not worked and they’ve adapted. So their, um, ability to get to market quicker can happen because they’re dealing with industry experts and we’re not like a top five consulting forum where we’ll bring one subject matter expertise in and then they bring a couple of Ivy League students into do all the work. We actually rotate our team based on their expertise. So in the beginning you might be working with someone that knows how to create an operational strategy and design a site and on the annual work with another one of our consultants as an accreditation expert. Um, so we’ll bring people in based on their expertise, but they have a long lineage and a long pedigree in specialty. And every day they look at ways to not only make our clients lives easier and more effective. They want to make sure that whatever they’re doing makes a difference in the patients that our clients are ultimately treating.
Speaker 1:11:25 Well, that’s the most important thing is, is that patient care and making sure the outcomes are, are the best that they can be. Absolutely. So one of my other question I have in, in, in this vein is, is uh, you know, again, some organizations you’re thinking is now the time for specialty pharmacy in my two big, am I too small? How does it work? What would you say to them in terms of why is the time now, why is now the best time to really consider a specialty pharmacy and how it fits into their organization?
Speaker 2:11:53 If anyone is taking a look at the pipeline of the drugs that are coming out in the next 10 to 15 years, they’re either oral or injectable products in most likely 50 to 60 percent of them will be a specialty product. So they’re going to have to make a determination if they want to be held hostage to the situation that the early example is. And wait for someone to take care of their patients for them or if they want to be proactive and have a complete approach to that care. I also think that you have to take a look at the changes in our reimbursement system. You know, our health system is fragmented right now, uh, and it’s not getting any better. And so there has to be in alignment with the payers of the world and value based reimbursement is coming out is something happens like in the incident that we talked about before, the little girl that passed away, what people don’t understand is the ripple effect of that health system.
Speaker 2:12:43 So now that that little girl passed away because their transplant was rejected, that event caused the health system to pay back all the money that they gave that insurer, whoever the payer was, whoever was that planned sponsor. So all that money goes back to them regardless that they had nothing to do with the adverse event. And as a center of excellence, if they have more adverse events, they could lose their, um, center of excellence and transplantation. And you know, what that’ll do to a health system that could just be a death sentence. Sure. It can be very devastating. So I’m a health system. Tell me how I can get started down the path of exploring specialty pharmacy. Well, the first thing is to call CSI, um, and we will talk to them and get to understand what are they trying to accomplish because we like to say in our office, if you’ve seen one health system or hospital, you’ve seen one health system or hospital, their missions may be different.
Speaker 2:13:41 Their patient population, their geographic location, and they may have an outpatient pharmacy or not. They may have started in specialty for their employees or not. We go through a whole, um, a list of questions so that we can ascertain where they’re at and where they want to be from that we usually like to go out and visit them again, kind of doing a day in the life. What are they doing today, what do they want to do tomorrow? And from there we’ll come up with, um, the statement of work to basically help them go through ’em what they want to develop. Some organizations don’t have a lot of hands and they’ll want us to be more hands on. We have projects that can last three months or three years. Again, it really depends on how heavy a lift they can they can do and how heavy of lift they want us to do.
Speaker 2:14:28 One of the things that they can also start out with, as any of our listeners today, we do run the only industry podcast dedicated to specialty pharmacy and it’s a CSI specialty group, especially pharmacy podcasts. Little bit of a mouthful, but I started that several years ago because there really is. There really isn’t any informational site tool resource for people in the industry to hear what’s happening. So every, every other week we do a podcast that’s either based around something happening in the industry. For example, the beginning of this year, we had a whole podcast on copay accumulators. It was something new that was coming out that would affect patients, um, or we’ll bring a vendor on a or someone that is in specialty pharmacy that has a story to share that has value to the listeners. Um, I think we’ve got about 46,000 listeners today, uh, that are on it and it, it’s funny, when I go to conferences, it’s very rewarding for me to have people tell me, thank you for doing that because nobody wants to educate us on this industry.
Speaker 2:15:32 They all want us to pay hundreds of thousands of dollars to consultants when a lot of what you give me at least gets me going in the right direction to make the right informed decision. And I think that’s an important point to make is in helping them get educated before they engage, whether it’s with you or with anyone. It’s they need those resources. In many cases you’re saying free resources helped get educated or at least close up the speed so then they know the questions to ask and the things to look for. So there’s some other things that you do as well. I think in that vein to, or that they should look forward to. We do, we started, I’m actually two years ago doing a state of specialty pharmacy report that’s put out annually and what we do is we survey stakeholders across both health systems, independent specialty pharmacy and manufacturers, and I believe this year we’re going to also have a, um, a fourth area or channel of payers so that we can get the perspective from for all four channels on specialty pharmacy.
Speaker 2:16:28 And what they’re seeing is trends. Uh, it’s been very interesting and very enlightening. And uh, to me it’s an honor when I see people quote us and other research, uh, so I know we’re doing something right and again, it’s to give back, you know, we love this industry. It’s very exciting. It’s very fast pace, but at the end of the day we’re taking care of very, very sick patients. It’s not patients that just need to take liberatory to lower their cholesterol. It’s people that need to take ms so they can get up in the morning and enjoy the day with their children. We never lose sight of the fact that the people that are relying on us are taking care of patients that are very, very sick and need that extra touch. And I think that in all of this, it’s the most important points to make specialty can be.
Speaker 2:17:11 I’m probably a little bit daunting to think about or to get into for any facility, but ultimately it’s about establishing that continuum of care and I think is one of your customer set and one of our members, Virginia Mason, I remember saying it’s the right thing to do. Getting into special thinking about specialty is the right thing to do in terms of the best way to treat their patient. That that’s absolutely right. And I think that there, for those that are late to the market and, and you know, to our listeners on this podcast, you know, really only 20 to 25 percent of health systems today have any type of specialty pharmacy offering. And of those 25 percent, maybe two percent are optimized. And what I mean by that is we have a lot of health systems coming to us now that are established. Especially the academic ids that are established, specialty pharmacies, they’ve only been able to capture 20 to 30 percent of their potential.
Speaker 2:18:06 The rest of it is going out to these very organizations that were the reason that this little girl didn’t get her medicine, so they need to think about that. They need to have a better or they need to have some sort of a strategy to increase their capture rate and we can help with that as well. So our services aren’t just for people that want to start a new specialty pharmacy. Our services are for people that want to make their specialty pharmacy the best it could possibly be and handle more of their physician’s needs and that’s a critical message to our listeners and again, it goes to continuum of care and making sure those patients like that little girl or taken care of in the best way possible. And the one thing that I would also stress to your members as well as that, as we take a look at specialty, this is what health systems do best.
Speaker 2:18:50 They take care of chronically ill patients so this isn’t new to them. What is new to them is getting access to the drugs, making sure they have the right systems to get reimbursed, figuring out ways to get that patient assistance and help so that they can get the financial burden, maybe lowered for that particular patients, stay on therapy, and then also making sure that they’re getting that product timely so the care is not unique. The delivery of the product and what that product needs to get to the patient is unique, so it’s not a big leap of faith. It’s just a new business line to add on to an existing successful when they have. It’s really good, really great
Speaker 1:19:29 information, so thanks very much is that for educating us on the importance of specialty pharmacy and understanding why healthcare organizations really need to have a strategy around it. It’s really good information. Thank you. Thank you for having me. This has been illuminated path podcast, shining a light on health care’s best operational practices. Thanks very much for listening and we hope to talk and walk with you again along the illuminated path very soon. If you’ve enjoyed this episode, make sure you subscribe to the illuminated path podcast, wherever you listen to podcasts. To learn more about Suzette CSI specialty group or insular, check out our show notes. Visit our website at [inaudible] dot com. Follow us on Linkedin, twitter, and facebook to learn when the latest episodes will be available and to keep up with all things into later.
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About The Specialty Pharmacy Podcast
Join host Suzette DiMascio, CHE, CMCE, CPC, President and CEO of CSI Specialty Group, as she answers questions, addresses concerns and discusses the news you need to stay on top of the ever evolving world of specialty pharmacy. Tune in every episode to hear real world examples of the good, the bad and the outrageous from the experts at CSI Specialty Group, and to learn about the limitless growth opportunities available in the specialty pharmacy industry.